10/16 Kipper PMPS 112

Hi Pat,

I really appreciate all your help. I think need to clarify Kippers dosing. DX 8/6, started 2 BID 8/26, bumped to 3 BID 8/31, bumped to 3 AM & 4 PM on 9/14, bumped to 4 BID on 9/25, dropped to 2 after a + 4 PM reading of 92 and an AMPS of 154 on 10/12 and 10/13. Then on 10/14 he got a 77 +8 am and a PMPS of 105 and that is when the vet said no PM insulin. Then on the 15th when Kippers AMPS was 517 the vet put him back to 3 units with instruction to test twice a day PS and if <200 no insulin and if >200 give 3 units. And that is where I have the problem. I understand the concept of the storage shed and feel that by not giving insulin he will always have high am numbers because the shed will be empty. But I am scared to give him 3 units when he is at 66.
I have a box with 3 cans of Friskies with gravy, two oral syringes, one infant nasal syringe, 1 bottle of Karo syrup and a jar of Vaseline and the printed direction for what to do. I’ll put the test strips in when I get an extra box. Am I ready?
For this evening Kipper’s numbers are 66 at +11.5, feed him and now at +12 he is 112. I’m not sure I am “data ready” to shoot but feel like I should give him a partial dose. Any thoughts?



I posted this on the main board and someone suggested I come here.

I'll try to make this short. For about the last 4 days I have been pretty pleased with Kippers numbers. I thought we might be heading toward regulation since the improvement started after I switched him to all wet food . Then yesterday he dropped to 77. Called the vet pre-shot for advice on dose. They had me feed, then test. Then they said no insulin. I felt he should maybe have .5 to 1 unit but since I have been at this a whopping two months and because he is not regulated, followed the vet's advice. This am he was 517 so the vet had me give 3 units. They told me to check at +5 and +7 then called back and said forget that, to only check twice a day pre-shot and the procedure changed to test, feed, shoot. As they are unavailable on the weekends I was told if <200 don't shoot or >200 give 3 units. I guess I shouldn't be second guessing my vet but not giving insulin at all seems scary. Giving too much insulin seems scary. I guess I don't like

The vet feels that testing Kipper more often is stressing him and delaying his regulation. But now with the suggested dosing schedule I don't see how I can not test him. I should mention that Kipper has peridontal disease and is scheduled for a dental on the 26th.

Any thoughts or words of encouragement?

Re: Need Feedback on Kippers Dosing

I've been at this a whopping 3 1/2 months, so I'll defer to those more knowledgeable about giving advice. But I did want to say hello and welcome to Lantus Land. There are great people here, and a ton of information and knowledge and help and guidance, so I'm sure you'll get your answers soon.

Re: Need Feedback on Kippers Dosing

Welcome to Lantus Land!

I guess I shouldn't be second guessing my vet but not giving insulin at all seems scary. Giving too much insulin seems scary.

Click to expand...

Yes you should! It doesn't sound like your vet is very familiar with Lantus. Lantus is a long lasting insulin which builds up a "shed" and takes time to work. Shifting the dose does not work with Lantus. Most of the dosing advisors are on the east coast and it's late there. Please read the Stickies at the top of the page. That will give you some basic understanding of how Lantus works.

A few points:

• Lantus dosing is based on the nadir, the lowest reading in a cycle
  We change doses usually by .25 units, sometimes less. Jumping to 3 units is a lot.
  We usually start low and work gradually up, no big jumps, with time to let the dose settle in between increases.
  It takes several days for the shed to fill and to see how the dose is actually working.
  We test a lot. It is the only way to know how the fur babies are reacting to the dose.

Please hang around or bump you post up in the morning, I'll try to remember to bump you up too. Start reading the stickies, that is going to keep you busy for awhile! :razz: Ask questions, the more you know the better. It is scary at first, but there are lots of us here to watch you back, just about 24/7.

Where are you. There might be someone nearby.

Re: Need Feedback on Kippers Dosing

Hi Sharon and Welcome to Lantus Land.

I'm sure the people on the Health board have already pointed out that testing doesn't "stress" our kitties. No doubt they aren't thrilled by the vet poking them but then vet stress is a pretty well established phenomenon. I test a lot and Gabby knows she's going to get a treat or food and doesn't mind. Others will point out that their cats will be sitting and waiting for them at their testing spot in advance of test time. So, let's get the myth that testing is a stressor that raises BG numbers out of the equation.

We suggest that you always get a pre-shot test and a minimum of one spot check per cycle. We also encourage you to do a curve (i.e., testing every 2 hours) or a mini-curve (testing every 3 hours) when you can. If you look at the starred sticky notes at the top, there is one on becoming data ready. Collecting test data will allow you to become data ready so you can shoot low numbers. If you look at the subject lines on the Board, you'll see some low pre-shot numbers followed by test information. With Lantus, it is very possible and ultimately desirable to shoot low number IF you are data ready.Most vets will not advise you to shoot the kinds of numbers we routinely shoot. They have a liability and they don't know whether you will be able to manage low numbers. We do this all the time with high carb food. With the 77, we would have suggested you get a test at +11, without having fed past +10. Depending on what your pre-shot test was, we would have suggested one of several options (i.e., stalling past your usual shot time to see if numbers were rising, giving a reduced dose, or skipping). We wouldn't make a decision to skip a shot based on a +7 number. We probably would have suggested getting a +7.5 to see if numbers were still dropping, though.

We also approach dosing very differently from the way your vet has apparently suggested. We usually change doses in increments of 0.25u based on the nadir, not the pre-shot BG value. It looks like you've been raising Kipper's dose by 1.0u. Please look at the sticky note on our dosing protocol. We use a protocol that has been developed by a veterinarian (Jacquie Rand, DVM) at the University of Queensland that's been published in the veterinary literature. By raising doses in such large amounts, it's very easy to miss an optimal dose.

What I would suggest is that you look over the sticky on our dosing protocol. If you are comfortable with the approach we use, or have more questions, we'll be happy to lend a hand. I don't think anyone here wants you to feel that we are trying to take over for your vet. Our approach is different from the one you've been advised to use and you need to be comfortable with how we use Lantus. What I can tell you is that I have a great deal of faith in my vet. I've also given her the Rand/Queensland protocol and she is aware that I am actively involved on this Board. She thinks I handle Gabby's diabetes competently. (She thinks I test too much. She also hasn't really noticed that I have a Drama Queen for a cat and I have a pretty good instinct when it comes to managing Gabby's numbers.)

Re: Need Feedback on Kippers Dosing

Thanks for your responses. I am in Reading PA. I have read the stickies but will go back and read again (probably several more times).

I have done 2 curves but am not sure where the nadir is. On 9/6 it seems to be +6 and on 10/3 +8. I certainly don't feel ready to shoot low numbers but would love to get there (soon). He has been in the 400's so long that this am's 205 looks low to me. I have cancelled an outing I had planned because I plan to shoot his normal dose and then become his shadow for the day and read stickies.
Thanks Again

Re: Need Feedback on Kippers Dosing

Just let us know how we can help! It's also a great way to learn to read condos, look at spreadsheets, and ask questions.

Re: Need Feedback on Kippers Dosing

Bump, Sienne is right, just don't look at Tess's yesterday, it'll scare you off. I have a drama queen. You might want to note in your signature that you use the Alpha Track. Most of us use human meters and the number range is a little lower.

Re: Need Feedback on Kippers Dosing

Hi Sharon and welcome to you and Kipper!

Here in LL we post a daily condo (thread) for our kitties and hope that you will be able to do that each day for Kipper.
We show in our heard Date, Cat's Name, AMPS:_____ and then update the head with any new BGs that we record, ie +1=__. We link our previous day's condo to the first post of each day. We welcome you to read other's condos and say hello...much can be learned by seeing what is happening with other kitties.
Here is the link to your post in Health: viewtopic.php?f=28&t=27508

In the Sticky "New to the Group" viewtopic.php?f=9&t=18139
you will find information on doing a curve. Also, there is a part about Hypos and it would be good to print that out to have handy. Also, in the Hypo Took Kit, there are things that you should always have on hand. Canned food that is high carb with gravy and karo syrup. Here is a link to the Janet & Binky's Food charts: http://binkyspage.tripod.com/canfood.html
Select a brand that is about 19% carb or higher from that list and have that on hand. We use the gravy alone to raise the BG numbers if they get low. Food is your friend. We can handle any numbers with food and our meter checks. You are in control! :razz:

I do hope you will be able to post each day and we are looking forward to seeing Kipper's progress :mrgreen:

Re: Need Feedback on Kippers Dosing

Thank you all for your responses.

Pat,

I would love to post daily and I'm sure it's simple but I'm not getting it. Can you tell me how to link my previous posts? Then I can start doing it right. I have been on tech forum but didn't find anything helpful.

Thanks in advance.

Re: Need Feedback on Kippers Dosing

welcome, kipper! you've got the wise folks helping you...just want to add...they have been immensely helpful and supportive to binks and i... seems they have had ENDLESS patience for a klutz like me! you'll like it here!

celi & binks

Re: Need Feedback on Kippers Dosing

Sharon....you will go through the list here and when you see your last condo, click on it and then you will see an address at the top of the page....it will begin with http://www.felinediabetes.com....and have other numbers at the end of that.
You will highlight that address...and then hit copy form the dropdown list in Edit.
Then, go back and click on New Topic. A blank post will come up where you will fill out your header for the day. In the body of the post yo will write Yesterday: and skip a few spaces, then from the drop down Edit list you will hit "Paste" and the HTTP address from that previous day's post will be put in your post. It will turn blue if it is linked correctly.
Did that help?

Re: Need Feedback on Kippers Dosing

Welcome you two! I just wanted to clarify what Pat said - the link won't turn blue when you paste it in, only after you hit the preview or submit button.

Re: Need Feedback on Kippers Dosing

Welcome to Lantus Land! You're getting wonderful input from highly experienced people. There's a lot to learn, and it can be a little confusing, even overwhelming at first, but you won't find a better place for putting Kipper on the road to health.

Re: Need Feedback on Kippers Dosing

Thank you all for the support and encouragement. Unless I have a panic attack later in the day I post again tomorrow using Pat's directions and we'll see what happens @-)

Re: Need Feedback on Kippers Dosing

Thank you all for the support and encouragement. Unless I have a panic attack later in the day I'll post again tomorrow using Pat's directions and we'll see what happens @-)

Re: Need Feedback on Kippers Dosing

Well I will link your previous condo if you can't do it so that's not a problem for now. what I am concerned about is your very high starting dose. As others have said, we usually go up in .25u increments from a lower starting dose. I am glad to see you are testing today.
Do you have any high carb canned food with gravy on hand as per my other post above?
Do you have karo syrup?
Those two things are mentioned in the Hypo section in that sticky I linked for you above also.
The focus is Kipper's dose and the numbers he is getting okay? Just keep posting any updates you have today...
You can back to your first post, click on the "edit" button and then put:
10/16 Kipper AMPS=205, +6=209

then you may add any other BG numbers you get today in the header in that format and alos post any questions yu might have in this condo.

Could you please take the candle out of your first post. A candle indicates a kitty that has crossed the Bridge (died).